Heart disease is gender-neutral and isn't anymore categorized as a man's disease. Continued research by the American Heart Association indicates that close to 43 million women in the U.S are affected by heart disease. 1 in 4 female deaths is due to heart disease. Diabetes, obesity, poor diet, physical inactivity and excessive consumption of alcohol are the key risk factors and 90% of women have one or more of these risk factors for developing heart disease.
Apart from these risk factors, in women who enter menopause, the tapering estrogen levels also increase the risk of developing cardiovascular disease. Estradiol is a form of estrogen, a female sex hormone produced by the ovaries. In women, the ovaries and reproductive tissues are involved in making estrogen. In men, testosterone is transformed into estrodiol. Though estrogen is considered a hormone of importance only to women, research and tests indicate that the imbalance poses health issues for men too. Be it excess or lack of estrogen levels, the imbalance increases the risk of degenerative diseases.
Thus it is proved that estrogen, primarily categorized as a sex hormone does cast its effect on heart health. The estradiol or E2 test procedure is the same for men, women and adolescents. In adolescents, the test is to assess early puberty or Precocious puberty. The test results are useful for healthcare providers to assess and analyze women's health issues such as menstrual problems, ovarian tumors, gynecomastia, menopausal problems and breast cancer. In men, high levels of estradiol are associated with abdominal fat, enlargement of the prostate and cardiovascular risk. Low levels of estrogen are associated with osteoporosis.
Too much of estrogen is estrogen dominance. Women who have opted for estrogen replacement may experience symptoms of estrogen dominance. In aging men, estrogen dominance can be natural phenomenon. Side effects of estrogen dominance are the same for men and women.
Besides, estrogen dominance accelerates the aging process. Men and women keen on avoiding estrogen dominance need to know the factors that contribute to estrogen dominance. Avoid those that contribute to increasing the level and bring healthy changes to live a healthy life.
Gonadotropin-releasing hormone (GnRH) is a neurohormone consisting of ten amino acids which is produced by the arcuate nuclei of the hypothalamus. It is integral for starting the reproductive hormone cascade.
GnRH is secreted in the hypothalamus which is part of the brain. The hypothalamus is part of the 'Hypothalamus - Pituitary - Gonad' axis which regulates the reproductive system in men and women. Secretion of GnRH by the hypothalamus is delivered through a direct pathway between the hypothalamus and pituitary. GnRH stimulates the synthesis and secretion of two gonadotrophins namely, lutenizing hormone (LH) and follicle stimulating hormone (FSH) by the anterior pituitary gland. Controlled by internal and external factors, GnRH acts in a negative feedback loop. For instance, if there is excess FSH, LH or testosterone, then these hormones will inhibit GnRH production.
Lifestyles can also affect GnRH secretion. Lack of exercise, poor diet, opiad drugs and excessive stress can negatively affect GnRH production. What is so striking in GnRH is that under normal circumstances, GnRH is released at intervals of 90 to 120 minutes. Hence, in patients with GnRH deficiency, the releasing hormone should be administered in pulses. Constant administration of GnRH also suppresses gonadotropin secretion especially in children in puberty stage and in men with prostate cancer.
Why is GnRH treatment used?
This hormone is produced by the hypothalamus and it stimulates the pituitary gland to produce LH and FSH. Lack of GnRH in the hypothalamus can halt testosterone production in the testicles of men. In women, abnormal GnRH levels can be responsible for ovulatory disorders.
This is commonly used when Clomid treatment has not stimulated egg follicles to develop on the ovaries. GnRH works effectively to replace the natural GnRH in women and men who do not produce enough of it. Failure of release of GnRH can result in deficiency that can be partial or complete.
In a woman who is not ovulating because of lack of stimulation from hypothalamus.
In a man who is not producing sperm because his hypothalamus is not stimulating the hormones that trigger sperm production.
The use of GnRH can result in multiple pregnancies.
Some studies report that the pregnancy rate after treatment with GnRH is about 20%.
Some side effects include:
The small pump that is used for GnRH may bother some people and treatment requires daily monitoring by a doctor.
Although clinicians and scientists have observed the findings of olfactory disturbances and reproductive dysfunction, the syndrome comprising complete GnRH deficiency and lack of olfactory senses is named Kallmann Syndrome after the American geneticist Kallmann who identified this disorder in 1944.
The choice of therapy depends upon the patient's desire to achieve one or more of the following options:
In males, treatment is decided to provide androgen replacement. The patient's age, potential adverse effects of therapy, patient's desire for fertility are considered. In the prepubertal male, GnRH stimulates penile growth, body and facial hair growth, bone and muscle development and voice changes. Androgens also stimulate growth hormone production, contributing to the adolescent growth spurt. Male androgen deficiency can result in social ridicule and therefore starting androgen therapy around age 14-15 is prudent.
Oral, injectable and transdermal and implantable pellets formulation are available for treatment of males with Kallmann syndrome. Oral androgen preparations should not be used due to their toxic effects on the liver and adverse effects on lipids. Injectable long-acting testosterone are low-cost, relatively safe and effective. The disadvantages include intramuscular injection and non physiologic pattern of testosterone over the dosing interval. There could be wide swings in libido in some men.
Transdermal patches and gel preparation of testosterone are currently available - adverse effect with these formulations include skin reactions at the application. In females as in males, treatment depends upon age and fertility desires. Estrogen replacement is a must to prevent osteoporosis.
Oral preparations, transdermal patches, vaginal cream and rings are available for standard hormone replacement therapy. Transdermally administered 17 beta estradiol has been shown as an effective regimen for preventing bone loss in normal menopausal women.
Women with intact uterus receive a cyclical progestin to accompany estradiol treatment. Optimal hormone therapy depends upon whether the patient has primary or secondary amenorrhea. Gradual dose escalation results in optimal breast development and allows time for young woman to adjust psychologically to her physical maturation.
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Bibliography / Reference
Collection of Pages - Last revised Date: February 21, 2020